title: Newborn care behaviours and neonatal survival: evidence from sub-Saharan Africa.
abstract: OBJECTIVE
  To review evidence from sub-Saharan Africa for the association between the practice or promotion of essential newborn care behaviours and neonatal survival.
  
  
  METHODS
  We searched MEDLINE for English language, peer-reviewed literature published since 2005. The study population was neonates residing in a sub-Saharan Africa country who were not HIV positive. Outcomes were all-cause neonatal or early neonatal mortality or one of the three main causes of neonatal mortality: complications of preterm birth, infections and intrapartum-related neonatal events. Interventions included were the practice or promotion of recommended newborn care behaviours including warmth, hygiene, breastfeeding, resuscitation and management of illness. We included study designs with a concurrent comparison group. Study quality was assessed using the Cochrane EPOC or Newcastle-Ottawa tools and summarised using GRADE.
  
  
  RESULTS
  Eleven papers met the search criteria and most were at low risk of bias. We found evidence that delivering on a clean surface, newborn resuscitation, early initiation and exclusive breastfeeding, Kangaroo Mother Care (KMC) for low-birthweight babies, and distribution of clean delivery kits were associated with reduced risks of neonatal mortality or the main causes of neonatal mortality. There was evidence that training community birth attendants in resuscitation and administering antibiotics, and establishing women's groups can improve neonatal survival.
  
  
  CONCLUSIONS
  There is a remarkable lack of robust evidence from sub-Saharan Africa on the association between practice or promotion of newborn care behaviours and newborn survival.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Penfold
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Willey
authors.forename: Joanna
authors.initials: J
authors.lastname: Schellenberg
mesh_terms: D017954:Africa South of the Sahara; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D018743:Perinatal Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality; D047928:Premature Birth
keywords: infant; infant care; newborn; sub-Saharan Africa